title: Transthoracic versus transhiatal esophagectomy for esophageal carcinoma: experience from a single tertiary care institution.
abstract: BACKGROUND
  There is a lot of controversy about the best surgical treatment for esophageal carcinoma.
  
  
  METHODS
  In this retrospective study, 382 patients with carcinoma of the mid-to-distal esophagus underwent transthoracic or transhiatal esophagectomy. Early morbidity and mortality were compared. Principal endpoints were disease-free survival (DFS) and overall survival (OS).
  
  
  RESULTS
  A total of 177 patients underwent transthoracic esophagectomy, and 205 patients underwent transhiatal esophagectomy. Demographic characteristics and characteristics of the tumor were similar in the two groups. Perioperative and postoperative morbidity was higher after transhiatal esophagectomy. In-hospital mortality was also higher after transhiatal esophagectomy. The median follow-up was 4.3 years. Estimated 3-year DFS rates were 44.63 and 31.21%, whereas the 3-year OS rates were 57.06 and 41.46% for the transthoracic and transhiatal groups, respectively (statistically significant). Also, the estimated 5-year DFS rates were 26.55 and 21.46%, whereas the 5-year OS rates were 32.76 and 30.24% for the transthoracic and transhiatal groups, respectively (statistically not significant).
  
  
  CONCLUSIONS
  Transhiatal esophagectomy was associated with higher perioperative and postoperative morbidity and in-hospital mortality than transthoracic esophagectomy. The DFS and OS were higher in the transthoracic group and were statistically significant at 3 years but statistically insignificant at 5 years.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Sher i Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, Kashmir, 190011, India. nadeem_kawoosa@yahoo.co.in
authors.forename: Nadeem UlNazeer
authors.initials: NU
authors.lastname: Kawoosa
authors.forename: Abdul Majeed
authors.initials: AM
authors.lastname: Dar
authors.forename: Mukand Lal
authors.initials: ML
authors.lastname: Sharma
authors.forename: Abdul Gani
authors.initials: AG
authors.lastname: Ahangar
authors.forename: Ghulam Nabi
authors.initials: GN
authors.lastname: Lone
authors.forename: Mohammad Akbar
authors.initials: MA
authors.lastname: Bhat
authors.forename: Shyam
authors.initials: S
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001707:Biopsy, Needle; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D003964:Diaphragm / Q000601:surgery; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome